Electrosurgical system energy source

ABSTRACT

An energy source for use with an electrosurgical system is disclosed. In one embodiment, the energy source includes a power supply, one or more capacitors coupled to the power supply, and a switching component coupled to the one or more capacitors. The switching component is configured to output pulses of a biphasic waveform. The pulses are capable of treating undesired tissue by inducing a change in voltage potential across cell membranes of a plurality of cells in the undesired tissue to promote non-thermal cell death in the plurality of cells. The pulses are also capable of treating the undesired tissue with no or minimal muscle contractions in patient tissue within reach of the biphasic waveform during treatment of the undesired tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under 35 U.S.C. § 120 to U.S. patent application Ser. No. 15/669,371, entitled ELECTROSURGICAL SYSTEM ENERGY SOURCE, filed Aug. 4, 2017, now U.S. Patent Application Publication No. 2018/0042661, which is a continuation application claiming priority under 35 U.S.C. § 120 to U.S. patent application Ser. No. 15/046,917, entitled ELECTROSURGICAL SYSTEM ENERGY SOURCE, filed Feb. 18, 2016, which issued on Oct. 17, 2017 as U.S. Pat. No. 9,788,885, which is a divisional application claiming priority under 35 U.S.C. § 121 to U.S. patent application Ser. No. 13/586,422, entitled ELECTROSURGICAL DEVICES AND METHODS, filed Aug. 15, 2012, which issued on Mar. 8, 2016 as U.S. Pat. No. 9,277,957, the entire disclosures of which are hereby incorporated by reference herein.

BACKGROUND

Electrosurgical therapy has been used in medicine for the treatment of undesirable tissue, such as, for example, diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths. Devices, systems, and methods for conventional ablation therapies may include electrical ablation therapies, such as, for example, high temperature thermal therapies including, focused ultrasound ablation, radiofrequency (RF) ablation, and interstitial laser coagulation, chemical therapies in which chemical agents are injected into the undesirable tissue to cause ablation, surgical excision, cryotherapy, radiation, photodynamic therapy, micrographic surgery, topical treatments with 5-fluorouracil, and laser ablation. Conventional electrical ablation therapies may suffer from some of the following limitations: cost, length of recovery, and extraordinary pain inflicted on the patient. In particular, one drawback of conventional electrical ablation therapies may be any permanent damage to healthy tissue surrounding the undesirable tissue due to detrimental thermal effects resulting from exposing the tissue to thermal energy generated by the electrical ablation device. For example, permanent damage to surrounding healthy tissue may occur when using high temperature thermal therapies to expose undesirable tissue to electric potentials sufficient to cause cell necrosis. Accordingly, electrosurgical devices, systems, and methods for the treatment of undesirable tissue having reduced or no detrimental thermal effects to surrounding healthy tissue are desirable.

FIGURES

The novel features of the various embodiments of the invention are set forth with particularity in the appended claims. The various embodiments of the invention, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.

FIG. 1 illustrates an electrosurgical system according to certain embodiments described herein.

FIG. 2 illustrates at least distal portions of a first electrode and a second electrode of an electrosurgical system according to certain embodiments described herein.

FIG. 3 illustrates at least distal portions of a first electrode and a second electrode of an electrosurgical system including sensors according to certain embodiments described herein.

FIG. 4 illustrates at least distal portions of a first electrode and a second electrode of an electrosurgical system including a temperature sensor according to certain embodiments described herein.

FIG. 5 is a graphical representation of an AC waveform that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 6 is a graphical representation of a series of electrical pulses of the AC waveform of FIG. 5 that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 7 is a graphical representation of multiple bursts of pulses of the AC waveform of FIG. 5 that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 8 is a graphical representation of electrode temperature during a series of electrical pulses that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 9 is a graphical representation of a porcine model's muscle electrical activity in response to DC monophasic pulses.

FIG. 10 is a graphical representation of a porcine model's muscle electrical activity in response to pulses of a biphasic AC waveform according to certain embodiments described herein.

FIG. 11 is a circuit block diagram of an electrosurgical system according to certain embodiments described herein.

FIG. 12 is a graphical representation of a treatment regimen generated and delivered by an electrosurgical system according to certain embodiments described herein.

FIG. 13 is a photograph of a porcine liver after receiving electrical pulses that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 14 is a graphical representation of a treatment regimen generated and delivered by an electrosurgical system according to certain embodiments described herein.

FIG. 15 is a photograph of a porcine liver after receiving electrical pulses that may be applied to undesirable tissue according to certain embodiments described herein.

FIG. 16 is a graphical representation of a treatment regimen generated and delivered by an electrosurgical system according to certain embodiments described herein.

FIG. 17 is a photograph of a porcine liver after receiving electrical pulses that may be applied to undesirable tissue according to certain embodiments described herein.

SUMMARY

In various embodiments, an energy source for use with an electrosurgical system is disclosed. In one embodiment, the energy source comprises a variable voltage power supply, at least one capacitor charged by the variable voltage power supply, and a switching amplifier receiving energy from the at least one capacitor. The switching amplifier is configured to output pulses of a biphasic radio frequency (RF) waveform. The pulses are capable of treating targeted tissue by inducing non-thermal cell death in the targeted tissue.

In various embodiments, an energy source for use with an electrosurgical system is disclosed. In one embodiment, the energy source comprises a variable voltage power supply, a plurality of capacitors electrically coupled to the power supply, and a switching amplifier electrically coupled to the plurality of capacitors. The switching amplifier is configured to output pulses of a biphasic alternating current (AC) waveform. The pulses are operative to treat targeted tissue by inducing a change in voltage potential across cell membranes of the targeted tissue.

In various embodiments, an energy source for use with an electrosurgical system is disclosed. In one embodiment, the energy source comprises a power supply, one or more capacitors coupled to the power supply, and a switching component coupled to the one or more capacitors. The switching component is configured to output pulses of a biphasic waveform. The pulses are capable of treating undesired tissue by inducing a change in voltage potential across cell membranes of a plurality of cells in the undesired tissue to promote non-thermal cell death in the plurality of cells.

DESCRIPTION

Applicant of the present application also owns U.S. patent application Ser. No. 13/586,439, entitled METHODS FOR PROMOTING WOUND HEALING, filed Aug. 15, 2012, now U.S. Patent Application Publication No. 2014/0052216, the entire disclosure of which is hereby incorporated by reference herein.

Various embodiments are directed to electrosurgical systems, and methods for the treatment of undesirable tissue while having reduced or no detrimental thermal effects to surrounding healthy tissue.

This disclosure describes various elements, features, aspects, and advantages of various embodiments of electrosurgical systems and methods thereof. It is to be understood that certain descriptions of the various embodiments have been simplified to illustrate only those elements, features and aspects that are relevant to a more clear understanding of the disclosed embodiments, while eliminating, for purposes of brevity or clarity, other elements, features and aspects. Any references to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment” generally means that a particular element, feature, and/or aspect described in the embodiment is included in at least one embodiment. The phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment” may not refer to the same embodiment. Persons having ordinary skill in the art, upon considering the description herein, will recognize that various combinations or sub-combinations of the various embodiments and other elements, features, and aspects may be desirable in particular implementations or applications. However, because such other elements, features, and aspects may be readily ascertained by persons having ordinary skill in the art upon considering the description herein, and are not necessary for a complete understanding of the disclosed embodiments, a description of such elements, features, and aspects may not be provided. As such, it is to be understood that the description set forth herein is merely an illustrative example of the disclosed embodiments and is not intended to limit the scope of the invention as defined solely by the claims.

All numerical quantities stated herein are approximate unless stated otherwise, meaning that the term “about” may be inferred when not expressly stated. The numerical quantities disclosed herein are to be understood as not being strictly limited to the exact numerical values recited. Instead, unless stated otherwise, each numerical value is intended to mean both the recited value and a functionally equivalent range surrounding that value. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding the approximations of numerical quantities stated herein, the numerical quantities described in specific examples of actual measured values are reported as precisely as possible.

All numerical ranges stated herein include all sub-ranges subsumed therein. For example, a range of “1 to 10” is intended to include all sub-ranges between and including the recited minimum value of 1 and the recited maximum value of 10. Any maximum numerical limitation recited herein is intended to include all lower numerical limitations. Any minimum numerical limitation recited herein is intended to include all higher numerical limitations.

As generally used herein, the terms “proximal” and “distal” generally refer to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” generally refers to the portion of the instrument closest to the clinician. The term “distal” generally refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.

In various embodiments, an electrosurgical system may generally comprise first and second electrodes coupled to an energy source. The energy source may generate and deliver pulses of a biphasic radio frequency (RF) waveform to a patient's tissue. The pulses may non-thermally treat and/or kill cells in undesirable tissue in a patient. The energy source may include an alternating current (AC) electrical waveform generator.

In various embodiments, an electrosurgical system may generally comprise first and second electrodes coupled to an energy source. The energy source may generate and deliver pulses of a biphasic radio frequency (RF) waveform to a patient's tissue. The pulses may induce changes in voltage potential across cell membranes in the tissue. The energy source may include an alternating current (AC) electrical waveform generator.

In various embodiments, an AC waveform generator may be configured to generate and deliver pulses of an AC waveform to a patient's tissue. The AC waveform may be characterized by peak-to-peak voltage amplitude and frequency referred to herein as “fundamental frequency f.” The electrical pulses may be characterized by various parameters, such as, for example, frequency, amplitude, pulse width (duration), total number of pulses, and delay between pulses.

In various embodiments, a method of treating undesirable tissue may generally comprise applying pulses of a biphasic RF waveform to the undesirable tissue to non-thermally treat and/or kill cells in the undesirable tissue. In other embodiments, a method of treating undesirable tissue may generally comprise applying pulses of a biphasic radio frequency (RF) waveform to the undesirable tissue to induce change in voltage potential across cell membranes in the undesirable tissue.

In various embodiments, a method of treating undesirable tissue may generally comprise deliver pulses of an AC waveform to a patient's tissue. The AC waveform may be characterized by peak-to-peak voltage amplitude and fundamental frequency f. The electrical pulses may be characterized by various parameters, such as, for example, frequency, amplitude, pulse width (duration), total number of pulses, and delay between pulses.

Without wishing to be bound to any particular theory, cell death in the treated undesirable tissue may occur directly following the treatment. Alternatively, cell death may occur later due to various biological mechanisms. In one theory, cell death may occur due to Irreversible Electroporation (IE). Electroporation, or electropermeabilization, is a significant increase in the electrical conductivity and permeability of the cell plasma membrane caused by an externally applied electrical field. It is usually used in molecular biology as a way of introducing some substance into a cell, such as a molecular probe, a drug that can change the cell's function, or a piece of coding Deoxyribonucleic acid (DNA). Electroporation is a dynamic phenomenon that depends on the local transmembrane voltage at each point on the cell membrane. It is generally accepted that for a given pulse duration and shape, a specific transmembrane voltage threshold exists for the manifestation of the electroporation phenomenon (from 0.5 V to 1 V). Irreversible Electroporation is thought to occur when the transmembrane threshold for a particular cell is surpassed leading to a destabilizing electric potential across cell outer membrane and causing formation of permanent nanoscale defects in the lipid bilayer. The permanent permeabilization of cell membrane leads to changes in cell homeostasis and cell death.

In another theory, cell death may occur due to apoptosis. Apoptosis is programmed cell death. Apoptosis involves a series of biochemical events that lead to a variety of morphological changes, including changes to the cell membrane such as loss of membrane asymmetry and attachment, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation.

In various embodiments, an electrosurgical system may generally comprise two or more electrodes configured to be positioned into or proximal to undesirable tissue in a tissue treatment region (e.g., a target site, or a surgical site). The tissue treatment region may have evidence of abnormal tissue growth. In general, the electrodes may comprise an electrically conductive portion (e.g., medical grade stainless steel, gold plated, etc.), and may be configured to electrically couple to an energy source. Once the electrodes are positioned into or proximal to the undesirable tissue, an energizing potential may be applied to the electrodes to create an electric field to which the undesirable tissue is exposed.

Various electrode designs, suitable for use with the present disclosure, described in commonly-owned U.S. Patent Application Publication No. 2009/0182332 A1 titled IN-LINE ELECTROSURGICAL FORCEPS, filed Jan. 15, 2008, the entire disclosure of which is incorporated herein by reference in its entirety, and commonly-owned U.S. Patent Application Publication No. 2009/0112063 A1 titled ENDOSCOPIC OVERTUBES, filed Oct. 31, 2007, the entire disclosure of which is incorporated herein by reference in its entirety.

Referring to FIG. 1, an electrosurgical system 10 is illustrated. The electrosurgical system 10 may be employed to treat undesirable tissue, such as, for example, diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths in a tissue treatment region using electrical energy. The electrosurgical system 10 may be configured to treat a number of lesions and ostepathologies comprising metastatic lesions, tumors, fractures, infected sites, and inflamed sites in a tissue treatment region using electrical energy. The electrosurgical system 10 may be configured to be positioned within a patient's natural body orifice, e.g., the mouth, anus, and vagina, and/or advanced through internal body lumen or cavities, e.g., the esophagus, stomach, intestines, colon, cervix, and urethra, to reach the tissue treatment region. The electrosurgical system 10 may be configured to be positioned and passed through a small incision or keyhole formed through the patient's skin or abdominal wall using a trocar to reach the tissue treatment region. The tissue treatment region may be located in the patient's brain, lung, breast, liver, gall bladder, pancreas, prostate gland, various internal body lumen defined by the esophagus, stomach, intestine, colon, arteries, veins, anus, vagina, cervix, fallopian tubes, and the peritoneal cavity. The electrosurgical system 10 may be used in conjunction with endoscopic, laparoscopic, thoracoscopic, open surgical procedures via small incisions or keyholes, percutaneous techniques, transcutaneous techniques, and/or external non-invasive techniques, and any combinations thereof.

Once positioned into or proximate the tissue treatment region, the electrosurgical system 10 may be actuated (e.g., energized) to treat the undesirable tissue. In one embodiment, the electrosurgical system 10 may be configured to treat diseased tissue in the gastrointestinal tract, esophagus, lung, and/or stomach that may be accessed orally. In another embodiment, the electrosurgical system 10 may be adapted to treat undesirable tissue in the liver or other organs that may be accessible using translumenal access techniques, such as, for example, NOTES™ techniques where the electrosurgical systems may be initially introduced through a natural body orifice and then advanced to the tissue treatment site by puncturing the walls of internal body lumen. In various embodiments, the electrosurgical system 10 may be adapted to treat undesirable tissue in the brain, lung, breast, liver, gall bladder, pancreas, or prostate gland, using one or more electrodes positioned percutaneously, transcutaneously, translumenally, minimally invasively, and/or through open surgical techniques, or any combination thereof.

Referring also to FIG. 1, the electrosurgical system 10 may be employed in conjunction with a flexible endoscope 12, as well as a rigid endoscope, laparoscope, or thoracoscope, such as the GIF-100 model available from Olympus Corporation. In one embodiment, the endoscope 12 may be introduced to the tissue treatment region trans-anally through the colon, trans-orally through the esophagus and stomach, trans-vaginally through the cervix, transcutaneously, or via an external incision or keyhole formed in the abdomen in conjunction with a trocar. The electrosurgical system 10 may be inserted and guided into or proximate the tissue treatment region using the endoscope 12. In other embodiments, the endoscope 12 is not utilized, and instead other techniques, such as, for example, ultrasound or a computerized tomography (CT) scan, may be used to determine proper instrument placement during the procedure.

As illustrated in FIG. 1, the endoscope 12 comprises an endoscope handle 34 and an elongate relatively flexible shaft 32. The distal end of the flexible shaft 32 may comprise a light source and a viewing port. Optionally, the flexible shaft 32 may define one or more channels for receiving various instruments therethrough, such as, for example, electrosurgical systems. Images within the field of view of the viewing port may be received by an optical device, such as, for example, a camera comprising a charge coupled device (CCD) usually located within the endoscope 12, and transmitted to a display monitor (not shown) outside the patient. In one embodiment, the electrosurgical system 10 may comprise a plurality of electrical conductors 18, a handpiece 16 comprising an activation switch 62, and an energy source 14, such as, for example, an electrical waveform generator, electrically coupled to the activation switch 62 and the electrosurgical system 10. The electrosurgical system 10 may comprise a relatively flexible member or shaft 22 (FIG. 4) that may be introduced to the tissue treatment region using any of the techniques discussed above, such as, an open incision and a trocar, through one of more of the channels of the endoscope 12, percutaneously, or transcutaneously.

Referring to FIGS. 1-4, one or more electrodes (e.g., needle electrodes, balloon electrodes), such as first and second electrodes 24 a,b may extend out from the distal end of the electrosurgical system 10. The first electrode 24 a may be configured as the positive electrode and the second electrode 24 b may be configured as the negative electrode. The first electrode 24 a may be electrically connected to a first electrical conductor 18 a, or similar electrically conductive lead or wire, which may be coupled to the positive terminal of the energy source 14 through the activation switch 62. The second electrode 24 b may be electrically connected to a second electrical conductor 18 b, or similar electrically conductive lead or wire, which may be coupled to the negative terminal of the energy source 14 through the activation switch 62. The electrical conductors 18 a,b may be electrically insulated from each other and surrounding structures, except for the electrical connections to the respective electrodes 24 a,b.

In certain embodiments, the electrosurgical system 10 may be configured to be introduced into or proximate the tissue treatment region using the endoscope 12 (laparoscope or thoracoscope), open surgical procedures, and/or external and non-invasive medical procedures. The electrodes 24 a,b may be referred to herein as endoscopic or laparoscopic electrodes, although variations thereof may be inserted transcutaneously or percutaneously. In various embodiments, one or both electrodes 24 a,b may be adapted and configured to slideably move in and out of a cannula, lumen, or channel defined within the flexible shaft 22.

When the electrodes 24 a,b are positioned at the desired location into or proximate the tissue treatment region, the electrodes 24 a,b may be connected to or disconnected from the energy source 14 by actuating or de-actuating the activation switch 62 on the handpiece 16. The activation switch 62 may be operated manually or may be mounted on a foot switch (not shown), for example. The electrodes 24 a,b may deliver electric field pulses to the undesirable tissue. The electric field pulses may be characterized by various parameters, such as, for example, pulse shape, amplitude, frequency, pulse width (duration), and total number of pulses.

Referring to FIG. 4, a protective sleeve or sheath 26 may be slidably disposed over the flexible shaft 22 and within a handle 28. In another embodiment, the sheath 26 may be slidably disposed within the flexible shaft 22 and the handle 28. The sheath 26 may be slidable and may be located over the electrodes 24 a,b to protect the trocar and prevent accidental piercing when the electrosurgical system 10 is advanced therethrough. One or both of the electrodes 24 a,b may be adapted and configured to slidably move in and out of a cannula, lumen, or channel formed within the flexible shaft 22. One or both of the electrodes 24 a,b may be fixed in place. One of the electrodes 24 a,b may provide a pivot about which the other electrode may be moved in an arc to other points in the tissue treatment region to treat larger portions of the diseased tissue that cannot be treated by fixing both of the electrodes 24 a,b in one location. In one embodiment, one or both of the electrodes 24 a,b may be adapted and configured to slidably move in and out of a working channel formed within a flexible shaft 32 of the endoscope 12 or may be located independently of the endoscope 12.

Referring to FIG. 1, the first and second electrical conductors 18 a,b may be provided through the handle 28. The first electrode 24 a may be slidably moved in and out of the distal end of the flexible shaft 22 using a slide member 30 to retract and/or advance the first electrode 24 a. The second electrode 24 b may be slidably moved in and out of the distal end of the flexible shaft 22 using the slide member 30 or a different slide member to retract and/or advance the second electrode 24 b. One or both electrodes 24 a,b may be coupled to the slide member 30, or additional slide members, to advance and retract the electrodes 24 a,b and position the electrodes 24 a,b. In this manner, the first and second electrodes 24 a,b, which may be slidably movable within the cannula, lumen, or channel defined within the flexible shaft 22, may be advanced and retracted with the slide member 30. As shown in FIG. 1, the first electrical conductor 18 a coupled to the first electrode 24 a may be coupled to the slide member 30. In this manner, the first electrode 24 a, which is slidably movable within the cannula, lumen, or channel within the flexible shaft 22, may be advanced and retracted with the slide member 30. In one embodiment, various slide members, such as the slide member 30, may be rotatable. Thus, rotation of the slide member 30 may rotate the corresponding electrode(s) at the distal end of the electrosurgical system 10.

Referring to FIG. 1, transducers or sensors 29 may be located in the handle 28 (or other suitable location) of the electrosurgical system 10 to sense the force with which the electrodes 24 a,b penetrate the tissue in the tissue treatment region. This feedback information may be useful to determine whether one or both of the electrodes 24 a,b have been properly inserted in the tissue treatment region. As is particularly well known, cancerous tumor tissue tends to be denser than healthy tissue, and thus greater force may be typically required to insert the electrodes 24 a,b therein. The transducers or sensors 29 may provide feedback to the operator, surgeon, or clinician to physically sense when the electrodes 24 a,b are placed within the cancerous tumor. The feedback information provided by the transducers or sensors 29 may be processed and displayed by circuits located either internally or externally to the energy source 14. The sensor 29 readings may be employed to determine whether the electrodes 24 a,b have been properly located within the cancerous tumor thereby assuring that a suitable margin of error has been achieved in locating the electrodes 24 a,b. The sensor 29 readings may also be employed to determine whether the pulse parameters need to be adjusted to achieve a desired result, such as, for example, reducing the intensity of muscular contractions in the patient.

Referring to FIG. 2, the electrosurgical system 10 may comprise a first flexible shaft 22 a housing the first electrode 24 a and a second flexible shaft 22 b housing the second electrode 24 b. The electrosurgical system 10 may comprise a first protective sleeve or sheath (not shown) disposed over at least one of the first flexible shaft 22 a and second flexible shaft 22 b. The electrosurgical system 10 may comprise a first protective sleeve or sheath (not shown) disposed over the first flexible shaft 22 a and a second protective sleeve or sheath (not shown) disposed over the second flexible shaft 22 b. The length of the first flexible shaft 22 a may be different than the length of the second flexible shaft 22 b. The length of the first flexible shaft 22 a may be greater than or equal to the length of the second flexible shaft 22 b. The length of the first protective sleeve or sheath may be different than the length of the second protective sleeve or sheath. The length of the first protective sleeve or sheath may be greater than or equal to the length of the second protective sleeve or sheath.

Referring to FIGS. 1-4, the electrosurgical system 10 may be configured to measure at least one of a temperature and a pressure. The transducers or sensors 29 may comprise at least one of a temperature sensor 25 (FIG. 3) and a pressure sensor 27 (FIG. 3). In certain embodiments, at least one of a temperature sensor 25 and pressure sensor 27 may be located in or proximate the electrosurgical system 10. The temperature sensor 25 and/or pressure sensor 27 may be located within the handle 28. The temperature sensor 25 and/or pressure sensor may be located within the protective sleeve or sheath 26. As shown in the embodiment of FIG. 3, the temperature sensor 25 and/or pressure sensor 27 may be located within the flexible shaft 22. The temperature sensor 25 and/or pressure sensor 27 may be located at the distal end of the flexible shaft 22. The protective sleeve or sheath 26 and/or the flexible shaft 22 may comprise one or more vents 31 configured for measuring at least one of the temperature and pressure of the tissue treatment region. The temperature sensor 25 and/or pressure sensor 27 may be located within the electrodes 24 a,b. The pressure sensor 27 may be adjacent to at least one of the vents 31. In one embodiment, the pressure sensor 27 may be adjacent at least one of the vents 31 and the temperature sensor 25 may be located at the distal end of the flexible shaft 22. FIG. 4 is a photograph of an electrosurgical system comprising an optical temperature sensor 29 located within a hollow lumen of the electrode 24 a at the distal end of the flexible shaft 22.

In certain embodiments, the temperature sensor and/or pressure sensor may be separate from the electrosurgical system 10. The electrosurgical system 10 may include the temperature sensor 25 and the pressure sensor may be separate from the electrosurgical system 10. The electrosurgical system 10 may include the pressure sensor 27 and the temperature sensor may be separate from the electrosurgical system 10.

According to certain embodiments, the temperature sensor 25 may measure the temperature of the tissue treatment region. The temperature sensor 25 may measure the temperature of the undesirable tissue. The temperature sensor 25 may measure the temperature of the tissue surrounding the electrodes. The temperature sensor 25 may measure the temperature before, during, and/or after treatment.

According to certain embodiments, the pressure sensor 27 may measure the pressure of the tissue treatment region. The pressure sensor 27 may measure the pressure of the space between the electrodes. The pressure sensor 27 may measure the pressure surrounding the electrodes. The pressure sensor 27 may measure the pressure before, during, and/or after treatment.

Without wishing to be bound to any particular theory, electrosurgical system 10 may treat and/or kill cells in undesirable tissue with no or minimal heat applied to the treated tissue, and thus, may not destroy the cellular support structure or regional vasculature. In various embodiments, the temperature of the tissue treated with electrosurgical system 10 may be maintained below or equal to 60° C. In other embodiments, the tissue temperature may be maintained below or equal to 50° C. In yet another embodiment, the tissue temperature may be maintained below or equal to 40° C. The temperature of the tissue may be monitored using the temperature sensor illustrated in FIG. 4.

In one embodiment, the output of the energy source 14 is coupled to the electrodes 24 a,b, which may be energized using the activation switch 62 on the handpiece 16, or an activation switch mounted on a foot activated pedal (not shown). Once electrical energy source 14 is coupled to the electrodes 24 a,b, an electric field may be formed at a distal end of the electrodes 24 a,b.

The electrodes 24 a,b may have a diameter or radius from 0.5 mm to 1.5 mm, such as, for example, 0.5 mm, 0.75 mm, 1 mm, and 1.5 mm. In various embodiments, the diameter of the first electrode 24 a may by different from the diameter of the second electrode 24 b. The electrode spacing may be from 0.5 cm to 3 cm. In various embodiments, the distance from the first electrode 24 a to the second electrode 24 b may be from 0.5 cm to 3 cm, such as, for example, 1 cm, 1.5 cm, 2.0 cm, and 3 cm. In one embodiment, the electrosurgical system 10 may comprise multiple needle electrodes.

According to certain embodiments, the electrosurgical system 10 may be introduced into the tissue treatment region through a trocar, for example, or inserted to a tissue treatment region transcutaneously, percutaneously, or other suitable techniques. In one embodiment, the cannula, lumen, or channel defined within the flexible shaft 22 may comprise a cutting edge, such as a bevel or other sharp edge, to aid in the puncturing/piercing of tissue.

FIG. 5 is a graphical representation of an AC waveform 80 generated by energy source 14 according to certain embodiments as described herein. Time (t) is shown along the horizontal axis and voltage (VAC) is shown along the vertical axis. The AC waveform 80 has a fundamental frequency f, and peak-to-peak voltage amplitude (VA_(pp)). In various embodiments, the AC waveform 80 may have a fundamental frequency f in the range of about 330 KHz to about 900 KHz, and peak-to-peak voltage amplitude (VA_(pp)) in the range of about 200 VAC to about 12,000 VAC. In other embodiments, the AC waveform 80 may have a fundamental frequency fin the range of about 400 KHz to about 500 KHz and peak-to-peak amplitude voltage (VA_(pp)) in the range of about 5,000 VAC to about 12,000 VAC. In one embodiment, the AC waveform 80 may have a fundamental frequency f of 500 KHz, and peak-to-peak voltage amplitude (VA_(pp)) of 12,000 VAC.

The energy source 14 may be configured to generate and deliver AC waveform 80 in pulses to treat substantial volumes of undesirable tissue in a treatment region with no or minimal thermal damage to surrounding tissue. Each pulse may have a duration T_(w) delivered at a pulse period T₁ or a pulse frequency f₁=1/T₁. A timing circuit may be coupled to the output of the energy source 14 to generate electric pulses. The timing circuit may comprise one or more suitable switching elements to produce the electric pulses.

The energy source 14 may be configured to generate and deliver AC waveform 80 in several bursts, each burst including several pulses. A treatment regimen may comprise several bursts spaced apart by sufficient time T_(b) to allow the temperature of the treated tissue to remain below a maximum temperature. The bursts may be delivered at a burst period T2 or a burst frequency f2=1/T2. Both pulse and burst frequencies may be varied within a particular treatment regimen to effectively treat target tissue while maintaining treated tissue temperature below a maximum temperature.

FIG. 6 is a graphical representation of a burst of electrical pulses of AC waveform 80 generated and delivered by energy source 14. Time (t) is shown along the horizontal axis and voltage (VAC) is shown along the vertical axis. Waveform 80 has a fundamental frequency f, and a voltage peak-to-peak amplitude (VA_(pp)). In this exemplary embodiment, the burst includes three pulses. Each pulse has a duration T_(w) delivered at a pulse period T₁ or a pulse frequency f₁=1/T₁. One of ordinary skill in the art will appreciate that the total energy delivered by each burst to the tissue can be varied by changing the voltage peak-to-peak amplitude (VA_(pp)), and/or the fundamental frequency f, the pulse width T_(w), and/or the pulse frequency f₁.

In various embodiments, each pulse may have pulse duration T_(w) in the range of about 5 microseconds to about 100 microseconds. In other embodiments, each pulse may have pulse duration T_(w) in the range of about 10 microseconds to about 50 microseconds. In one embodiment, each pulse may have pulse duration T_(w) of 20 microseconds. In various embodiments, the pulses may be delivered at pulse frequency f₁ in the range of about 1 Hz to about 500 Hz. In certain embodiments, pulse frequency f₁ may be in the range of about 1 Hz to about 100 Hz. In one embodiment, pulse frequency f₁ may be for example 4 Hz.

FIG. 7 is a graphical representation of multiple bursts of electrical pulses generated and delivered by energy source 14. Time (t) is shown along the horizontal axis and voltage (VAC) is shown along the vertical axis. In this exemplary embodiment, energy source 14 generates and delivers waveform 80 in three bursts. Each burst includes four pulses. Each pulse has a duration T_(w) delivered at a pulse period T or a pulse frequency f₁=1/T₁. In addition, the bursts are spaced apart by sufficient time T_(b) to allow the temperature of the treated tissue to remain below a maximum temperature. The bursts repeat at a burst frequency f₂=1/T₂.

In various embodiments, the bursts may repeat at a burst frequency f₂ in the range of about 0.02 Hz to about 500 Hz. In certain embodiments, burst frequency f₂ may be in the range of about 1 Hz to about 100 Hz. The number of bursts generated and delivered in a treatment regimen may also be varied to maintain tissue temperature below a maximum temperature. The number of bursts may be in the range of about 1 to about 100 bursts. In certain embodiments, the number of bursts may be in the range of about 5 to about 50 bursts.

Without wishing to be bound to any particular theory, in one aspect, temperature may be related to distance between electrodes. As shown in FIG. 8, an electrode spacing of 1.5 cm generated a maximum temperature of about 51° C. at the positive electrode and an electrode spacing of 1.0 cm generated a maximum temperature of about 59° C. at the positive electrode. As shown in FIG. 8, the temperature increases as the distance between the electrodes decreases. Temperature is also related to the total energy delivered to the tissue by electrosurgical system 10. During a particular treatment regimen, the various parameters of waveform 80 may be varied to ensure an effective treatment without undesirable overheating of the treated tissue.

In various embodiments, electrosurgical system 10 may treat and/or kill cells in undesirable tissue with no or minimal muscle contractions in a treated patient. It is well known that neural and muscle cells are electrically excitable, i.e. they can be stimulated by electric current. It is believed that sensitivity of the nerve and muscle cells to electric field is due to the voltage-gated ion channels present in their cell membranes. In patients, such stimulation may cause acute pain, muscle spasms, and even cardiac arrest. Typically, the sensitivity to electrical stimulation decreases with increasing frequency. Furthermore, it is also believed that neural and muscle cells are more sensitive to direct current. To minimize the effects of muscle and neural stimulation, electrosurgical system 10 may be configured to generate and deliver electric pulses of a biphasic AC waveform operating at a high fundamental frequency f such as in the range of about 330 KHz to about 900 KHz and peak-to-peak voltage amplitude (VA_(pp)) of about 200 VAC to about 12,000 VAC.

In various embodiments, a patient may be treated with electrosurgical system 10 without administering a paralytic agent. A paralytic agent is generally administered to reduce skeletal muscle contractions and cardiac events when a patient is treated with monophasic pulses.

FIGS. 9 and 10 are graphical representations of the severity of muscle contractions in a porcine model treated with monophasic pulses, in FIG. 9, and treated with electrosurgical system 10, in FIG. 10. Time (t) is shown along the horizontal axis and voltage (V) is shown along the vertical axis. Each treatment was delivered percutaneously via 2 needles spaced 1.5 cm apart in a porcine liver in absence of a paralytic agent. A standard BIOPAC system, readily available from BIOPAC Systems Inc. at Goleta, Calif., was utilized to record the change in muscle electrical activity in response to each treatment. FIG. 9 illustrates the severity of muscle contractions upon administration of two monophasic bursts. In comparison, FIG. 10 illustrates the severity of muscle contractions upon administration of two bursts generated and delivered by electrosurgical system 10. In this example, electrosurgical system 10 was configured to generate and deliver two bursts of an AC waveform operating at a fundamental frequency f of 500 KHz. Changes in voltage amplitude of each recording correspond to changes in muscle electrical activity. As evident by comparing FIGS. 9 and 10, the severity of muscle contractions, in the absence of a paralytic agent, is several orders of magnitude higher in the case of monophasic pulses.

Referring to FIG. 1, the energy source 14 may include a variable voltage power supply, a capacitor charged by the variable voltage power supply, and a switching amplifier which receives energy from the capacitor. The switching amplifier may be configured to output pulses of a biphasic radio frequency (RF) waveform capable of treating tissue by inducing non-thermal cell death in the tissue with no or minimal muscle contractions in a patient during treatment of the tissue.

The switching amplifier is a full bridge amplifier having a first phase of operation and a second phase of operation. The full bridge amplifier may be configured to output a positive voltage during the first phase of operation, and a negative voltage during the second phase of operation. Furthermore, the full bridge amplifier may be configured to alternate between the first and second phases of operation. The full bridge amplifier may include four switching legs. Each switching leg may have at least one switching element, and at least one drive circuit to control the at least one switching element. In certain embodiments, the energy source 14 may further include a drive logic to drive the drive circuits of at least two of the switching legs simultaneously during the first phase of operation, and to drive the drive circuits of at least two other switching legs simultaneously during the second phase of operation.

The energy source 14 may further include an isolating transformer having an energy input side and an energy output side. The energy input side may be configured to receive energy from the switching amplifier. The isolating transformer may be configured to minimize induction of low frequency energy from the energy input side to the energy output side. In at least one embodiment, the energy source 14 may further include a blocking capacitor configured to remove low frequency energy from the output of the switching amplifier.

In various embodiments, energy source 14 may comprise a configuration as illustrated in FIG. 11, energy source 14 may include a system Input/Output (I/O) board 102, a variable voltage power supply 104, and a switching amplifier 106. The power supply 104 may be a high voltage direct current (DC) power supply with voltage amplitude in the range of about 0 VDC to about 3000 VDC. Energy source 14 may further include a system Input/Output (I/O) board 102, which controls the output of the power supply 104. A computer interface may be used to interact with the system I/O board 102 to set the amount of DC voltage output of the power supply 104.

In various embodiments, power supply 104 may charge several capacitors 109. In certain embodiments, capacitors 109 are configured to store large amounts of energy. Capacitors 109 suitable for such purpose include large bank, high quality, and high pulse current metalized polypropylene capacitors. Capacitors 109 may be charged by power supply 104 during the “OFF” time of the switching amplifier 106. Upon switching the switching amplifier 106 to the “ON” position, capacitors 109 may discharge the energy stored within into the switching amplifier 106.

In certain embodiments, as illustrated in FIG. 11, the switching amplifier 106 may be configured as a full bridge amplifier. In at least one embodiment, the switching amplifier 106 may be configured as a class D full bridge amplifier. The switching amplifier 106 may include a number of switching legs 111. In at least one embodiment, as illustrated in FIG. 11, the switching amplifier may include four switching legs 111. Each switching leg 111 may include power Biopolar Field Effect Transistors (BiFETs) 108, and associated drive circuits 110. By way of example, as illustrated in FIG. 11, each switching leg 111 may include three power BiFETs 108, and associated drive circuits 110. In certain embodiments, to be able to withstand high-voltage stress from power supply 104, the power BiFETs 108 of each switching leg 111 may be configured in series. That said, other configurations such as parallel should not be excluded from the scope of the present disclosure. In certain embodiments, switching leg 111 may turn ON simultaneously in a Class D operation to efficiently transfer the energy from the capacitors 109, charged by the power supply 104, into output circuitry.

In certain embodiments, as illustrated in FIG. 11, the switching amplifier 106 is configured with a first phase of operation (phase 1) and a second phase of operation (phase 2). In certain embodiments, the switching amplifier 106 is configured to output positive voltage during phase 1 and negative voltage during phase 2. A driver logic 102 may be configured to operate each phase at the appropriate time. In certain embodiments, driver logic 102 is configured to alternate between phase 1 and phase 2.

In certain embodiments, Phase 1 is begun after charging the capacitors 109. During phase 1, a positive voltage may be produced on one side of an output transformer 112. Phase 2 is begun after Phase 1 is ended. During Phase 2, a negative voltage may be produced on the same side of the output transformer. In certain embodiments, an anti-overlap time between phase 1 and phase 2 ensures that there is no pass through current when phase 2 is begun. In most cases, the anti-overlap time is so small that it cannot be seen in the output waveform. An additional anti-overlap time may be applied before the repeat of the cycle. The output of the switching amplifier 106 is a switching, biphasic waveform.

In certain embodiments, the output transformer 112 may be an isolating transformer. In at least one embodiment, output transformer 112 may be a 1:2 isolating transformer capable of doubling the voltage of the output waveform. For example, if the capacitors 109 are charged to 3000 VDC, the output transformer 112 may increase the voltage of the output waveform to a 6000 V positive peak and a 6000 V negative peak. In certain embodiments, output transformer 112 may include primary 113 and secondary 115 windings that are isolated with double insulating material. The isolation of the primary windings 113 from the secondary windings 115 protects and isolates the secondary windings 115 from the DC voltage characteristics contained within the primary windings 113 of the output transformer 112. Such isolation may aid in eliminating low frequency energy.

In certain embodiments, as illustrated in FIG. 11, each leg 114 of the output transformer 112 is connected to a blocking capacitor 116. The blocking capacitors 116 may be configured to pass high frequency energy, and block low frequency energy to ensure that the energy source 14 delivers high frequency biphasic current to treated tissue.

In various embodiments, energy source 14 may include thermistors for monitoring tissue temperature. As shown in FIG. 11, a first thermistor 118 is employed at a positive lead and a second thermistor 120 is employed at a negative lead. An isolated, thermal sensing circuit 122 may record temperature and report this information to the system I/O board 102. The information can then be processed and the output of energy source 14 adjusted to maintain an appropriate temperature.

In Various embodiments, energy source 14 may comprise current sensors to monitor the current flowing through the switching amplifier 106. As illustrated in FIG. 11, current sensor 124 may comprise a current sensing circuit 126, and a current sensing isolating transformer 128. Current sensors protect BiFETs 108 of the switching amplifier 106 from power overload by terminating the system if operative current reaches excessive amounts.

The embodiments of the electrosurgical systems described herein may be introduced inside a patient using minimally invasive or open surgical techniques. In some instances, it may be advantageous to introduce the electrosurgical systems inside the patient using a combination of minimally invasive and open surgical techniques. Minimally invasive techniques may provide more accurate and effective access to the treatment region for diagnostic and treatment procedures. To reach internal treatment regions within the patient, the electrosurgical systems described herein may be inserted through natural openings of the body such as the mouth, anus, and/or vagina, for example. Minimally invasive procedures performed by the introduction of various medical devices into the patient through a natural opening of the patient are known in the art as NOTES™ procedures. Surgical devices, such as an electrosurgical systems, may be introduced to the treatment region through the channels of the endoscope to perform key surgical activities (KSA), including, for example, electrosurgical of tissues using irreversible electroporation energy. Some portions of the electrosurgical systems may be introduced to the tissue treatment region percutaneously or through small—keyhole—incisions.

Endoscopic minimally invasive surgical and diagnostic medical procedures are used to evaluate and treat internal organs by inserting a small tube into the body. The endoscope may have a rigid or a flexible tube. A flexible endoscope may be introduced either through a natural body opening (e.g., mouth, anus, and/or vagina). A rigid endoscope may be introduced via trocar through a relatively small—keyhole—incision incisions (usually 0.5 cm to 1.5 cm). The endoscope can be used to observe surface conditions of internal organs, including abnormal or diseased tissue such as lesions and other surface conditions and capture images for visual inspection and photography. The endoscope may be adapted and configured with channels for introducing medical instruments to the treatment region for taking biopsies, retrieving foreign objects, and/or performing surgical procedures.

Once an electrosurgical system is inserted in the human body internal organs may be reached using trans-organ or translumenal surgical procedures. The electrosurgical system may be advanced to the treatment site using endoscopic translumenal access techniques to perforate a lumen, and then, advance the electrosurgical system and the endoscope into the peritoneal cavity. Translumenal access procedures for perforating a lumen wall, inserting, and advancing an endoscope therethrough, and pneumoperitoneum devices for insufflating the peritoneal cavity and closing or suturing the perforated lumen wall are well known. During a translumenal access procedure, a puncture must be formed in the stomach wall or in the gastrointestinal tract to access the peritoneal cavity. One device often used to form such a puncture is a needle knife which is inserted through the channel of the endoscope, and which utilizes energy to penetrate through the tissue. A guidewire is then feed through the endoscope and is passed through the puncture in the stomach wall and into the peritoneal cavity. The needle knife is removed, leaving the guidewire as a placeholder. A balloon catheter is then passed over the guidewire and through the channel of the endoscope to position the balloon within the opening in the stomach wall. The balloon can then be inflated to increase the size of the opening, thereby enabling the endoscope to push against the rear of the balloon and to be feed through the opening and into the peritoneal cavity. Once the endoscope is positioned within the peritoneal cavity, numerous procedures can be performed through the channel of the endoscope.

The endoscope may be connected to a video camera (single chip or multiple chips) and may be attached to a fiber-optic cable system connected to a “cold” light source (halogen or xenon), to illuminate the operative field. The video camera provides a direct line-of-sight view of the treatment region. If working in the abdomen, the abdomen may be insufflated with carbon dioxide (CO₂) gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. CO₂ gas is used because it is common to the human body and can be removed by the respiratory system if it is absorbed through tissue.

Once the electrosurgical systems are located at the target site, the diseased tissue may be electrically ablated or destroyed using the various embodiments of electrodes discussed herein. The placement and location of the electrodes can be important for effective and efficient electrosurgical therapy. For example, the electrodes may be positioned proximal to a treatment region (e.g., target site or worksite) either endoscopically or transcutaneously (percutaneously). In some implementations, it may be necessary to introduce the electrodes inside the patient using a combination of endoscopic, transcutaneous, and/or open techniques. The electrodes may be introduced to the tissue treatment region through a channel of the endoscope, an overtube, or a trocar and, in some implementations, may be introduced through percutaneously or through small—keyhole—incisions.

Preferably, the various embodiments of the devices described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

The various embodiments described herein may be better understood when read in conjunction with the following representative examples. The following examples are included for purposes of illustration and not limitation.

An electrosurgical system comprising a first and second electrodes coupled to an energy source comprising an AC waveform generator, and a temperature sensor according to certain embodiments was used to deliver an AC waveform 80 in a series of electrical bursts ex vivo to healthy porcine liver (Dose 1). As illustrated in FIG. 12, Dose 1 includes 100 bursts. Each burst has a burst period T₂ or a burst frequency, f2=1/T₂, of 0.5 Hz. Each burst includes 2 pulses. Each pulse has a duration T_(w) of 20 microseconds delivered at a pulse period T₁ or a pulse frequency, f₁=1/T₁, of 4 Hz. The AC waveform 80 operates at fundamental frequency of 500 KHz and has peak-to-peak voltage amplitude (VA_(pp)) of 12,000 V. The temperature was monitored using the temperature sensor illustrated in FIG. 4, and was maintained below or equal to 60° C. FIG. 13 includes a photograph of porcine liver after the treatment with Dose 1. In this instance, the first and second electrodes were positioned 1.5 cm apart.

An electrosurgical system comprising a first and second electrodes coupled to an energy source comprising an AC waveform generator, and a temperature sensor according to certain embodiments was used to deliver an AC waveform 80 in a series of electrical bursts ex vivo to healthy porcine liver (Dose 2). As illustrated in FIG. 14, Dose 2 may include 60 bursts. Each burst has a burst period T₂ or a burst frequency, f2=1/T₂, of 0.2 Hz. Each burst includes 5 pulses. Each pulse has a duration T_(w) of 20 microseconds delivered at a pulse period T₁ or a pulse frequency, f₁=1/T₁, of 4 Hz. The AC waveform 80 operates at fundamental frequency of 500 KHz and has peak-to-peak voltage amplitude (VA_(pp)) of 12,000 V. The temperature was monitored using the temperature sensor illustrated in FIG. 4 and was maintained below or equal to 60° C. FIG. 15 includes a photograph of porcine liver after the treatment Dose 2. In this instance, the first and second electrodes were positioned 1.5 cm apart.

An electrosurgical system comprising a first and second electrodes coupled to an energy source comprising an AC waveform generator, and a temperature sensor according to certain embodiments was used to deliver an AC waveform 80 in a series of electrical pulses ex vivo to healthy porcine liver (Dose 3). As illustrated in FIG. 16, Dose 3 includes 250 pulses. Each pulse has a duration T_(w) of 20 microseconds delivered at a pulse period T₁ or a pulse frequency, f₁=1/T₁, of 500 Hz. The AC waveform 80 operates at fundamental frequency of 500 KHz and has peak-to-peak voltage amplitude (VA_(pp)) of 12,000 V. The temperature was monitored using the temperature sensor illustrated in FIG. 4 and was maintained below or equal to 60° C. FIG. 17 includes a photograph of porcine liver after the treatment with Dose 3. In this instance, the first and second electrodes were positioned 1.5 cm apart.

The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device may be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular elements, and subsequent reassembly. In particular, the device may be disassembled, and any number of particular elements or components of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular components, the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

Preferably, the various embodiments described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

It is preferred that the device is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam, autoclaving, soaking in sterilization liquid, or other known processes.

Although various embodiments have been described herein, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 

1-24. (canceled)
 25. An energy source configured to deliver, via a plurality of electrodes, a plurality of pulses of a biphasic radio frequency (RF) waveform to a target tissue, wherein the biphasic RF waveform operates at a fundamental frequency greater than that which electrically stimulates muscular cells, and wherein the plurality of pulses induce non-thermal cell death in the target tissue without a measurable stimulation in muscular tissue exposed to the biphasic RF waveform.
 26. The energy source of claim 25, wherein the energy source comprises an alternating current waveform generator.
 27. The energy source of claim 25, wherein the biphasic RF waveform operates at the fundamental frequency of about 330 KHz to about 900 KHz and a peak-to-peak voltage amplitude of about 200 VAC to about 12,000 VAC.
 28. The energy source of claim 25, wherein the biphasic RF waveform operates at the fundamental frequency of about 400 KHz to about 500 KHz and a peak-to-peak voltage amplitude of about 5,000 VAC to about 12,000 VAC.
 29. The energy source of claim 25, further configured to deliver the plurality of pulses in a plurality of bursts, and wherein each burst includes a number of pulses.
 30. The energy source of claim 29, further configured to deliver the number of pulses in each burst at a pulse frequency of about 1 Hz to about 100 Hz.
 31. The energy source of claim 29, further configured to delivery the plurality of bursts at a burst frequency of about 1 Hz to about 100 Hz.
 32. An energy source configured to deliver, via a plurality of electrodes, a plurality of pulses of a biphasic alternating current (AC) waveform to a target tissue, wherein the biphasic AC waveform operates at a fundamental frequency greater than that which electrically stimulates muscular cells, and wherein the plurality of pulses induce a change in voltage potential across cell membranes in the target tissue without a measurable effect in muscular tissue exposed to the biphasic AC waveform.
 33. The energy source of claim 32, wherein the measurable effect comprises a contraction in the muscular tissue.
 34. The energy source of claim 32, wherein the plurality of pulses treat the target tissue without perceptible thermal damage to patient tissue surrounding the target tissue.
 35. The energy source of claim 32, wherein the biphasic AC waveform operates at the fundamental frequency of about 330 KHz to about 900 KHz and a peak-to-peak voltage amplitude of about 200 VAC to about 12,000 VAC.
 36. The energy source of claim 32, wherein the biphasic AC waveform operates at the fundamental frequency of about 400 KHz to about 500 KHz and a peak-to-peak voltage amplitude of about 5,000 VAC to about 12,000 VAC.
 37. The energy source of claim 32, further configured to deliver the plurality of pulses in a plurality of bursts, and wherein each burst includes a number of pulses.
 38. The energy source of claim 37, further configured to deliver the number of pulses in each burst at a pulse frequency of about 1 Hz to about 100 Hz.
 39. The energy source of claim 37, further configured to delivery the plurality of bursts at a burst frequency of about 1 Hz to about 100 Hz.
 40. An energy source configured to deliver, via a first electrode and a second electrode, a series of pulses of a biphasic waveform to a target tissue, wherein the biphasic waveform operates at a fundamental frequency greater than that which electrically excites muscular cells, wherein the series of pulses induce a change in voltage potential across cell membranes of a plurality of cells in the target tissue, and wherein the series of pulses induce non-thermal cell death in the plurality of cells without a measurable excitation of muscular tissue during treatment of the target tissue.
 41. The energy source of claim 40, wherein the biphasic waveform operates at the fundamental frequency of about 330 KHz to about 900 KHz and a peak-to-peak voltage amplitude of about 200 VAC to about 12,000 VAC.
 42. The energy source of claim 40, wherein the biphasic waveform operates at the fundamental frequency of about 400 KHz to about 500 KHz and a peak-to-peak voltage amplitude of about 5,000 VAC to about 12,000 VAC.
 43. The energy source of claim 40, further configured to deliver the series of pulses in a plurality of bursts.
 44. The energy source of claim 43, further configured to delivery the plurality of bursts at a burst frequency of about 1 Hz to about 100 Hz. 